Healthcare Provider Details

I. General information

NPI: 1982613246
Provider Name (Legal Business Name): ALYSSA R HOVERSON SCHOTT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALYSSA R HOVERSON MD

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 DEMERS AVE
EAST GRAND FORKS MN
56721-1833
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 218-773-5858
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number48913
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number40404
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number11319
License Number StateND
# 4
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMN-48913
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: